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Acute sinusitis - A severe infection in one or both maxillary sinuses erectile dysfunction treatment herbs order nizagara 25 mg mastercard, characterized by a constant treatment of erectile dysfunction in unani medicine order 50mg nizagara overnight delivery, "heavy," debilitating pain that changes intensity with changes in head position and may be accompanied by heavy discharge of mucus or pus from the affected sinus. Addiction - Physical or emotional dependence, or both, on a substance, such as alcohol or drugs. Adrenocortical crisis - An emergency situation caused by inability of the adrenal cortex to produce sufficient corticosteroids in the presence of stress, such as during a dental appointment. Aggressive periodontitis - Aggressive periodontal disease that leads to rapid attachment loss and periodontal bone destruction. Alcohol abuse - the continued excessive use of alcohol despite the development of social, legal, or other health problems related to alcohol use. Alcohol dependence - A chronic disease characterized by a strong craving for alcohol, a constant or periodic reliance on use of alcohol despite adverse consequences. The individual is unable to limit drinking, and physical illness occurs when drinking is stopped. The individual needs to consume an increasing amount of alcohol to experience its effects. The disease usually begins in later middle life with slight defects in memory and behavior that become progressively more severe. Amotivational syndrome - A loss of interest and desire to study or work, decreased energy or productivity, and generalized apathy, sullenness, moodiness, and inability to concentrate. Angina - A spasmodic, often severe pain in the chest caused by reduced blood flow to the heart. Symptoms of stable angina are predictable and usually occur after stress or physical exertion. Unstable angina is chest pain that is unpredictable and often occurs without exertion and at night. Bulimia - Episodic binge eating followed by purging in an attempt to prevent weight gain. The process of purging most often takes the form of self-induced vomiting, but can also involve the use of laxatives. Calcified canals - the presence of calcified material in the root canal space, often making such teeth more difficult to treat endodontically. Camouflaging - Orthodontically displacing teeth relative to the supporting bone to compensate for an underlying jaw discrepancy. This technique is used primarily to improve facial esthetics and as an alternative to orthognathic surgery. Caries control - Any and all efforts to prevent, arrest, remineralize, or restore carious lesions. Caries control protocol - A comprehensive plan designed to arrest or remineralize early carious lesions, to eradicate overt carious lesions, and to prevent the formation of new lesions in a person who has a moderate or high rate of caries formation or who is at significant risk for developing future caries. Cellulitis - A diffuse soft tissue infection with swelling and poorly defined borders. Cheilitis - An inflammatory condition of the lips and angles of the mouth characterized by chapping and fissuring. Chronic apical periodontitis - An inflammatory process at the apex of a tooth, characterized by radiographic change in the form of a widened periodontal ligament space, usually in the absence of pain. In the dental inter- Anorexia nervosa - A pathologic, psychosocial disorder manifested by extreme aversion to food and an intense fear of gaining weight. Anterograde amnesia - A form of amnesia in which new events are not transferred to long-term memory. Anxiety - A response to an anticipated experience that the person perceives as threatening in some way. Anxiolytics - Anxiety-relieving medications used in the management of fearful patients. Aphasia - A deficiency in the ability to understand or communicate the spoken or written word.

The dentist who gains a reputation for aggressively pointing out the shortcomings of another dentist runs two serious risks: (1) he or she may be called to testify for a patient-plaintiff in a lawsuit and (2) he or she may lose patients who suspect that finding fault with the earlier work represents a practice-building strategy erectile dysfunction medicines buy nizagara pills in toronto. Before suggesting a remedy erectile dysfunction korean ginseng buy nizagara no prescription, the dentist should carefully assess whether the restorative problem currently causes tissue damage or inflammation and, if it does, the level of significance of the resulting periodontal problem. If no current problem exists, the dentist determines what future periodontal problems can be anticipated. When informed of the nature of the defect, the magnitude of the current periodontal problem, the potential for further deterioration, and the treatment options available, the patient can select a course of action. It is noteworthy that in this situation many practitioners only offer two options: no treatment or replacement of the existing restoration. This sometimes technically demanding procedure is infrequently taught in most dental colleges. Nevertheless, the dentist has at his or her disposal an array of conventional instruments to accomplish the task including burs, 156 Phases of the Treatment Plan helpful. The rubber-tipped stimulator or Perio-Aid may be useful in selected sites that brush or floss cannot reach. Stimudents are a less commonly used alternative to conventional approaches, but with proper technique, also can be very effective. Some patients with poor manual dexterity may benefit from use of a floss holder and an electric toothbrush. Powered toothbrushes have been shown to be very effective in plaque removal and have gained popularity with many patients, even those who have good dexterity. They are particularly advantageous for patients with special needs, such as the visually impaired and the frail elderly. Regardless of the technique recommended, it is critical that the patient be able to implement it effectively. Teaching and learning good oral self care is a complex process and should not be taken lightly by the dental team or the patient (Figure 7-8). The patient must not only be able to hear and understand the instruction, but also must be able to demonstrate the technique in the office and then repeat it at home. The learning process may be slow and laborious and can be frustrating to all parties, but is definitely worth the effort because the rewards are significant and if the effort fails, the outcome can be devastating to the patient. Once the techniques are learned, the use of each prescribed oral home care aid should be reviewed and reinforced at subsequent visits. Extraction of Hopeless Teeth In some instances, it will already have been determined that selected teeth are to be removed because of severe advanced periodontal disease, nonrestorability caused by severe decay or fracture, or in preparation for placing prosthodontic appliances. Such extractions usually should be carried out before or during scaling and root planing. Delay of inevitable extractions may give false hope, and leave the patient deflated and discouraged when the teeth finally are lost. It may be appropriate to maintain hopeless teeth temporarily until a replacement prosthesis has been prepared, to preserve appearance, if their retention prevents the imminent tipping or extrusion of other teeth, or if their removal would compromise the vertical dimension of occlusion. Elimination of Iatrogenic Restorations and Open Carious Lesions Contributing to Periodontal Disease Before any scaling is initiated, it is preferable to eliminate all open carious lesions or defective restorations that may interfere with the effective removal of plaque. In such cases, localized scaling at that specific site should be completed before or at the time of the tooth restoration preparation. Anatomic defects such as root fluting or concavities or exposed furcation areas- which often require surgical correction-are typically managed later. Similarly, orthodontic correction of a root proximity problem normally is delayed until the definitive phase of care. Marginal ridge discrepancies, open proximal contacts, and plunger cusps may be repairable with odontoplasty in the disease control phase or, if more severe, may need to be corrected with complex restorations during definitive treatment. Although comprehensive occlusal adjustment should not be performed before scaling and root planing, significant occlusal interferences causing acute occlusal trauma or trauma-related mobility should be eliminated as part of the disease control phase. Scaling and Root Planing Scaling and root planing constitutes the central element in the periodontal component of the disease control phase.

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A more detailed investigation is warranted when the patient has pain impotence foods buy nizagara 50mg low price, an inability to chew impotence used in a sentence discount nizagara 100 mg, or a limited opening (<25 mm). When possible, any radiographs made by previous dentists should be obtained, particularly those less than 3 years old. Chapter 1 Information Gathering and Diagnosis Development 17 Radiographs should be made only when the diagnostic benefits outweigh the risks of exposure to ionizing radiation. The dentist decides which type of radiograph to obtain based on patient age, clinical findings, and oral health history. Certain factors place a patient at higher risk for oral problems, necessitating a more extensive radiographic survey (Box 1-2). The primary intraoral exposures are periapical, interproximal (or bite-wing), and occlusal projections. Dentists typically use radiographs to examine for signs of pathologic conditions, caries, periodontal and periapical problems, remnants of missing teeth, and the quality of existing dental restorations. Periapical radiographs should show all of a particular tooth and the surrounding bone. Useful for imaging the teeth, detecting caries, and documenting signs of periodontal and periapical disease, they are limited by their size and the need to be placed in the mouth. A complete mouth survey of a completely dentate patient usually consists of 16 to 20 periapical radiographs along with four interproximal radiographs (Figure 1-9). Horizontal and vertical interproximal or bite-wing radiographs show the coronal portion of the teeth in both arches and the alveolar crestal bone. Most frequently used for the detection of interproximal caries and for evaluating the crestal bone height, bite-wing radiographs are also valuable as a screening tool for patient evaluation before deciding to make posterior periapical radiographs. In adults, their use is limited to visualizing palatal lesions and searching for impacted or supernumerary teeth. The film can also be helpful in documenting expansion of bone in the mandible and salivary stones in the ducts of the submandibular gland (Figure 1-10). The panoramic radiograph (also referred to as a pantomograph) displays a wide area of the jaws, and hence, enables evaluation of structures not covered by intraoral projections (Figure 1-11). Relatively easy to expose, the radiographs may help detect developmental anomalies, pathologic lesions of the teeth and jaws, or other bone fractures. In adults, dentists most commonly use this radiograph to evaluate third molar position or the condition of edentulous areas of the jaws before fabricating removable prosthodontics or placing implants. Because of the lower resolution and superimposition of structures on the film, a panoramic radiograph does not have the fine detail necessary to diagnose caries or document periodontal bone loss. There are several situations in which imaging information in the third dimension is beneficial in diagnosis and treatment planning. Some examples include the placement of dental implants, evaluation of the relationship of third molar root tips to the mandibular canal before surgery, assessment of bony expansion for pathologic jaw lesions, and the analysis of jaw relationships in orthodontics. The Treatment Planning Process New patient being evaluated for dental diseases and dental development Recall patient with clinical caries or at increased risk for caries* Posterior bite-wing exam at 12-24 month intervals if proximal surfaces cannot be examined visually or with a probe Not applicable Recall patient with no clinical caries and not at increased risk for caries* Posterior bite-wing exam at 18-36 month intervals Not applicable Recall patient with periodontal disease Clinical judgment as to the need for and type of radiographic images for the evaluation of periodontal disease; imaging may consist of, but is not limited to , selected bite-wing and/or periapical images of areas where periodontal disease (other than nonspecific gingivitis) can be identified clinically Clinical judgment as to need for and type of radiographic images for evaluation and/or monitoring of dentofacial growth and development Clinical judgment as to need for and type of radiographic images for evaluation and/or monitoring of dentofacial growth and development Panoramic or periapical exam to assess developing third molars Usually not indicated Not applicable Patient for monitoring of growth and development Patient with other circumstances including, but not limited to , proposed or existing implants, pathologic conditions, restorative/endodontic needs, treated periodontal disease, and caries remineralization Clinical judgment as to need for and type of radiographic images for evaluation and/or monitoring in these circumstances Chapter 1 Information Gathering and Diagnosis Development From the American Dental Association, U. Food and Drug Administration: the selection of patients for dental radiograph examinations. The patient exhibits radiographic signs of rampant dental caries and a pulpal pathology. Chapter 1 Information Gathering and Diagnosis Development 21 dedicated to maxillofacial imaging are available (Figures 1-12, 1-13). This equipment permits acquisition of 3-D images with a lower radiation dose than with a medical scanner. As the image quality improves and equipment costs become more reasonable, the move to filmless, digital radiology has gained momentum. Advantages of digital radiology include decreased radiation exposure for patients, the capability of manipulating images to improve diagnosis, and the elimination of film processing chemicals and equipment. Disadvantages include the cost of devices and equipment, conversion of previous films to digital images, the thickness and rigidity of the sensors, the high cost when a sensor is lost or broken, and difficulty in sharing images among different computer systems. Individual casts show the position and inclination of teeth and can be used to create matrices for fabricating temporary restorations. Study models should be obtained and mounted on an articulator to evaluate occlusal relationships whenever prosthodontic treatment is being planned. The dentist can also use mounted casts to evaluate the necessity for preprosthetic surgery, especially in the edentulous patient with large maxillary tuberosities. Note the fractured clinical crown #22 and a fracture at the right angle of the mandible.

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